1. Statement of the Technical Field
The present invention relates to an orthopedic device. More particularly, the invention relates to an orthosis for the treatment of illnesses of the wrist and elbow.
2. Description of the Related Art
In tendinosis, wear and tear in the wrist and elbow joints is thought to lead to tissue degeneration. Numerous occupational and recreational activities often exacerbate the tendinosis. Such activities include, but are not limited to, typing, grasping a computer mouse, gardening, playing racket sports, and picking up and holding objects. A degenerated tendon, such as the tendons in the wrist and elbow, usually has an abnormal arrangement of collagen fibers. As a result, the body produces an inflammatory response. Special inflammatory cells make their way to the injured tendinous tissues to assist in the healing process.
In wrist injuries, this inflammation is sometimes manifested in or around the carpal and/or ulnar tunnels, compressing the nerves running through these tunnels. When the inflammation is centered around the medial nerve of the wrist, a condition known as carpal tunnel syndrome is produced. When the inflammation is centered around the ulnar nerve, a condition known as ulnar tunnel syndrome is produced. Typical symptoms of carpal and ulnar tunnel syndromes include, but are not limited to, tingling, numbness, night time wakening, pain, coldness, and weakness in parts of the hand.
In elbow injuries, the inflammation is often manifested around the lateral or medial epicondyles of the humeral bone. When the inflammation surrounds the lateral epicondyl, it is commonly referred to as “tennis elbow,” or lateral epicondylitis. When the inflammation is centered around the medial epicondyl, it is commonly referred to as “golfer's elbow,” or medial epicondylitis.
In the case of lateral or medial epicondylitis, the body produces a type of cells called fibroblasts. When this occurs, the collagen fibers in the elbow tendon lose their strength. These fibers become fragile and can break with too much physical activity, developing small tears in the forearm tendon. Although the body tries to heal these small tears, constant strain and overuse keep re-injuring the tendon. Each time the collagen fibers break down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue and the healing process loses its effectiveness. The scar tissue never has a chance to fully heal, leaving the injured areas weakened and painful.
In addition to the aforementioned medical conditions, there can also be inflammation of the fluid filled tissue sheath (called synovium) that surrounds the tendons of the wrist and/or elbow. This inflammatory condition is commonly called tenosynovitis of the wrist and/or elbow. When the wrist and/or elbow tendons are inflamed, the synovium swells. As a result, the tendons cannot slide easily through the synovium, causing swelling and pain at the wrist and/or elbow joints.
Another medical condition, known as mogigraphia or “writer's cramp,” refers to a disorder of the hand due to excessive fine motor activity. Writer's cramp is thought to result from a problem of motor control involving the basal ganglia of the brain. Common manifestations of simple writer's cramp include excessive gripping of the pen, flexion, and sometimes deviation of the wrist, elevation of the elbow, and occasional extension of a finger or fingers causing the pen to fall from the hand. Sometimes the disorder progresses to include the elevation of shoulders or the retraction of the arm while writing.
In the field of orthopedics, there are numerous treatment options for treating writer's cramp, tendinosis and related illnesses of the wrist and elbow. Over the years, some of the treatment devices and methods in this particular area have been the use of supports, wraps, armbands with or without air bubbles, static splinting and casting with fiberglass or plaster materials, as well as magnets, ultrasound, acupuncture, physical therapy, cortisone patches and/or injections, ice/heat packs, and anti-inflammatory medications.
Various other treatment methods attempt to treat the condition by immobilizing the muscle(s), tendons, ligaments, and/or capsular structures to prevent their use. This idea of immobilization is based upon an agonist-antagonist functional interaction in every activity of the elbow, forearm, wrist, hand and fingers. The rationale for immobilization is to relax the muscle to allow it to heal. Relaxing the muscle in this way can ameliorate, modify, and reduce inflammation.
There have been many attempts in the art to design an orthosis for the elbow joint to treat tendinosis and related illnesses of the wrist and elbow. For example, U.S. Pat. No. 5,662,595 to Chesher et al. provides a supination-pronation orthosis for the elbow joint. The orthosis includes a hand and wrist cuff that restricts wrist flexion, essentially immobilizing the wrist joint. A flexible torsion unit is mounted to extend between the upper arm cuff and the hand and wrist cuff along the forearm of the patient. The torsion unit selectively opposes rotation of the forearm of the patient about the elbow joint.
U.S. Pat. No. 4,899,735 to Townsend et al. discloses a torsion bar splint for a patient's forearm. The device retains and restricts the forearm in the position to which it is rotated.
U.S. Patent Application Pub. No. US2004/0138597 to Varn teaches a dorsal blocking hand orthosis. The orthosis has a rigid hand splint member which has a forearm portion attached to a finger portion, which are adapted to receive a patient's hand so that a forearm portion and a splint member rest on the dorsal portion of the patient's wrist and forearm.
However, one drawback to the devices shown in the art is that restricting a muscle's use by permanent joint immobilization can cause joint stiffness. Some other major problems associated with permanently immobilizing the elbow joint and/or wrist joint include joint stiffness, contractures, muscle atrophy, skin irritation, and functional restrictions.
It is also known in the medical and scientific literature, and specifically in the field of hand surgery, that tendons can be repaired and sewn together. Typical methods used in treating a post-operative patient are to allow the repaired tendons to heal by an external fixation device that immobilizes movement at the elbow joint. As discussed, such a device can cause stiffness (contractures, muscle atrophy, skin irritation, and functional restrictions) in the neighboring joints.
Therefore, what is needed in the art is an orthosis that can restrict the contraction of muscles connected to tendons attached at either the lateral or medial epicondyles. At the same time, the orthosis should not immobilize movement at the wrist and elbow joints. Thus, the orthosis should allow the muscle(s) tendons, ligaments, and/or capsular structures in question to relax to prevent aggravating the tendinosis and its related illnesses of the wrist and elbow.